Respiratory

System
 COPD (Chronic obstructive pulmonary disease)
Emphysema
Lungs damaged
Airways becomes narrow and partly blocked
Hard to breath
Most common cause – smoking
The airways and air sacs lose their elasticity
(like an old rubber band)
The walls between many of the air sacs
(alveoli) are destroyed
The walls of the airways become thick and
inflamed (swollen)
Cells in the airways make more mucus
(sputum) than usual, which tends to clog the
airways
Lower Respiratory
 Drug Treatment Goals
COPD Asthma
Reverse inflammation and
Relieve bronchospasm
bronchoconstriction

Achieve normal or near

Reduce secretions normal pulmonary
function

Decrease frequency of
Manage infection
attacks

Correct hypoxemia

Improve quality of life by

maximizing lung function
Lower Respiratory
Stop smoking NOW

Lower Respiratory
 Assessment
Person
• Symptoms, frequency, severity
• Precipitating factors
• Alleviating factors
• Pulmonary Function Test (PFT), PEFR
• Drug history
• Co-morbidities

Drugs
• β2-agonists
• Methylxanthines
• Anticholinergics
• Antiallergy Agents
• Corticosteroids
• Leukotriene receptor antagonists

A miracle drug is one that has now the same price Lower Respiratory
 β2 agonists (Bronchodilators)

Non-
selective • Epinephrine
β2

Selective • Metaproteronol
• Salbutamol
β2

Lower Respiratory
• Increase ciliary motility
• Inhibit histamine release from mast cells
• Decrease GI tone
• Increase blood sugar

β1 + β2
• Decrease vascular permeability
• Lungs
β2
• Relax bronchi smooth muscle
• Heart
• Increase myocardial contractility
β1
• Increase heart rate
β2 agonists (Bronchodilators)
 β2 agonists (Bronchodilators)
Effective for early phase

Will not inhibit:

Late phase inflammatory response

Bronchial hyperresponsiveness

Long-acting salmeterol (Serevent)

Not for acute phase

Lower Respiratory
Methylxanthines (Bronchodilators)
Theophylline (Nuelin)
Inhibit phosphodiasterase
Enzyme responsible for breaking down cAMP
cAMP = Cyclic adenosine monophosphate
cAMP = Intracellular messenger stimulating
bronchodilation
Inhibiting phosphodiasterase leaves more cAMP available
Improved mucociliary clearance
Alleviate early phase and bronchoconstrictive portion of late phase
Non-respiratory actions
Diuresis
Gastric acid secretion
Reduced lower esophageal pressure
Lower Respiratory
 Anticholinergics
Ipratropium (Atrovent)

Block action of acetylcholine by inhibiting

the binding to receptors

Acetylcholine is bronchocontrictor in

large airways

Acetylcholine increases mucus secretion

Does not cause bronchodilation

Lower Respiratory
Antiallergy agents
Inhibit release of histamine and other

chemicals from mast cells

Depress exaggerated neuronal reflexes

triggered by irritants

Decrease airway sensitivity

Block early and late reactions from

occurring

Lower Respiratory
 Corticosteroids
Budesonide (Pulmicort)

Suppress:

Cytokine production

Airway eosinophil recruitment

Release of inflammatory chemicals

Decrease airway inflammation, bronchoconstriction, edema

Alter mucus gland function

Increase effect of beta-agonists

Not effective in early phase response

 Leukotriene receptor antagonists
Leukotrienes

More potent bronchoconstrictors than

histamines

Enhance responsiveness of airways

Stimulate mucus secretion

Montelukast (Singulair) – once daily

Prevent binding to receptors in airways

rahim@msu.edu.my Lower Respiratory
Leukotriene receptor antagonists

Lower Respiratory
 Considerations: COPD
Non-pharmacologic
Smoking cessation
Exercise
Adequate nutrition
Weight reduction
Avoid infection

Mild
Anticholinergic
Anticholinergic + β agonist
Long acting methylxanthine

Moderate
Anticholinergic + β agonist
Long acting methylxanthine

Severe
Anticholinergic + β agonist
Long acting methylxanthine
Inhaled / oral corticosteroid Lower Respiratory
 Assessment: Adverse reactions
Inhaled steroids
Headache, throat itching, hoarseness,
dry mouth
Localized infections
Suppression of HPA
Antiallergy
Headache
Irritation of trachea,
bronchospasm
Unpleasant taste (nedocromil)
Short-acting β agonists
Headache, tremors, tachycardia
Hypokalemia, hyperglycemia
Longer-acting β agonists
Tachycardia
Increased QT interval
Anticholinergic
Mucus plugging if dehydrated
Not for use in BPH, glaucoma
Leukotreine antagonists
Headache, dry mouth, somnolence
Methylxanthines
Headache, nervousness, insomnia
Gastric upset, aggravation of ulcer, GERD
Tachycardia, palpitations, diuresis
Lower Respiratory
THANK YOU